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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Code: 3860 Name: _______________________________ Address: _____________________________ ______________________________ Telephone Number: ____________________ Appearing in Proper Person IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE ______________________________________ Plaintiff/Petitioner, vs. ______________________________________ Defendant/Respondent. __________________________________________/ Case No. ________________________ Dept. No. ________________________ AFFIDAVIT OF PERSONAL SERVICE STATE OF NEVADA COUNTY OF WASHOE ) ) ) _______________________________________________________ being first duly sworn, (Name of person who served the Order) deposes and says under the penalties of perjury: 1. That I am a citizen of the United States, over 18 years of age, and am not a party to this action. 2. That a copy of the EX-PARTE EMERGENCY MOTION and the ORDER were personally served upon ________________________________________________ on the _______ (Name of the person who was served) day of _______________________, 20______, in the City of ______________________________, by personally delivering a copy of such documents to the above-named person at the following Revised 2005 1 American LegalNet, Inc. www.USCourtForms.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 address: _________________________________________________________________________ _______________________________________________________________________________. DATED this _______ day of __________________________, 20______. ____________________________________________ (Signature of person who served the Order) SUBSCRIBED and SWORN to before me this _______day of _______________________, 20______. _________________________________________ NOTARY PUBLIC Revised 2005 2 American LegalNet, Inc. www.USCourtForms.com